Effects of Candida colonization on patients with ventilator-associated pneumonia and pathogenic microorganisms: Systematic review and meta-analysis

IF 2.1 4区医学 Q3 INFECTIOUS DISEASES

Diagnostic microbiology and infectious disease Pub Date : 2024-10-26 DOI:10.1016/j.diagmicrobio.2024.116580

Yushan Liu , Tingting Xu , Qiwen Tan , Lijuan Xiong

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Abstract

Background

In the intensive care unit (ICU), patients undergoing mechanical ventilation (MV) often exhibit Candida colonization. This study aims to systematically review and analyze the effects of Candida colonization on the outcomes of mechanically ventilated patients and its relationship with bacterial pathogens associated with ventilator-associated pneumonia (VAP).

Methods

We conducted a comprehensive search across PubMed, Embase, Web of Science (WOS), and the Cochrane Central Register of Controlled Trials (CENTRAL) without language restrictions to identify eligible studies. Inclusion criteria involved patients undergoing MV for >2 days, encompassing those with clinically suspected VAP (csVAP), and confirmed VAP patients. We assessed the impact of Candida colonization on patient prognosis, length of ICU stay, bacterial pathogens responsible for VAP, and inflammatory markers. The study protocol was registered with PROSPER (CRD42024580547).

Results

Thirteen studies involving 3,802 patients were included in our analysis. The prevalence of Candida colonization among MV patients ranged from 10 % to 56 %. Our findings indicated that Candida airway colonization was associated with poorer patient prognosis (95 % CI 1.13-1.52, p < 0.05, I² = 39 %). Among patients who developed VAP, Candida colonization correlated with increased detection rates of Pseudomonas aeruginosa (RR = 1.37, 95 % CI 1.07-1.75, p = 0.01, I² = 3 %) and Acinetobacter baumannii (RR= 1.48, 95 % CI 1.17-1.86, p < 0.01, I² = 27 %). Additionally, an association with antibiotic resistance was observed, although the quality of evidence was low. In studies that recorded patients' inflammatory markers, no significant effect of Candida colonization on inflammatory markers (procalcitonin, interleukin-6) was observed.

Conclusion

Candida airway colonization is highly prevalent among mechanically ventilated patients and should be considered a marker of poor prognosis when it occurs. Antibiotics should be used more carefully when Candida colonization is detected in the respiratory tract of mechanically ventilated patients.

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念珠菌定植对呼吸机相关肺炎患者和病原微生物的影响：系统回顾和荟萃分析。

背景：在重症监护病房（ICU），接受机械通气（MV）的患者通常会出现念珠菌定植。本研究旨在系统回顾和分析念珠菌定植对机械通气患者预后的影响及其与呼吸机相关肺炎（VAP）细菌病原体的关系：我们对 PubMed、Embase、Web of Science (WOS) 和 Cochrane 对照试验中央注册中心 (CENTRAL) 进行了全面检索，以确定符合条件的研究。纳入标准包括接受 MV 治疗超过 2 天的患者，包括临床疑似 VAP（csVAP）患者和确诊 VAP 患者。我们评估了念珠菌定植对患者预后、重症监护室住院时间、导致 VAP 的细菌病原体和炎症指标的影响。研究方案已在 PROSPER 注册（CRD42024580547）：我们的分析包括 13 项研究，涉及 3802 名患者。中风患者的念珠菌定植率从 10% 到 56% 不等。我们的研究结果表明，念珠菌气道定植与患者较差的预后有关（95 % CI 1.13-1.52, p < 0.05, I² = 39 %）。在发生 VAP 的患者中，念珠菌定植与铜绿假单胞菌（RR=1.37，95 % CI 1.07-1.75，p = 0.01，I² = 3 %）和鲍曼不动杆菌（RR=1.48，95 % CI 1.17-1.86，p < 0.01，I² = 27 %）检出率增加相关。此外，还观察到与抗生素耐药性有关，但证据质量较低。在记录了患者炎症指标的研究中，没有观察到念珠菌定植对炎症指标（降钙素原、白细胞介素-6）有明显影响：结论：念珠菌气道定植在机械通气患者中非常普遍，一旦发生应被视为预后不良的标志。当在机械通气患者的呼吸道中发现念珠菌定植时，应更谨慎地使用抗生素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diagnostic microbiology and infectious disease 医学-传染病学

CiteScore

5.30

自引率

3.40%

发文量

149

审稿时长

56 days

期刊介绍： Diagnostic Microbiology and Infectious Disease keeps you informed of the latest developments in clinical microbiology and the diagnosis and treatment of infectious diseases. Packed with rigorously peer-reviewed articles and studies in bacteriology, immunology, immunoserology, infectious diseases, mycology, parasitology, and virology, the journal examines new procedures, unusual cases, controversial issues, and important new literature. Diagnostic Microbiology and Infectious Disease distinguished independent editorial board, consisting of experts from many medical specialties, ensures you extensive and authoritative coverage.